Provider Demographics
NPI:1396031498
Name:CONNECTED KIDS PEDIATRIC THERAPY, PC
Entity Type:Organization
Organization Name:CONNECTED KIDS PEDIATRIC THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:847-502-8348
Mailing Address - Street 1:15 COMMERCE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 COMMERCE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7807
Practice Address - Country:US
Practice Address - Phone:847-502-8348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty